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Substance Use Disorders > Stimulant Use Disorder > Flashcards

Stimulant Use Disorder Flashcards

1
Q

Stimulant use disorder (SUD) is classified as…

A

An inappropriate use of stimulants, leading to clinically significant impairment/distress

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2
Q

Diagnostic criteria as per the DSM defines 3 categories, including…

A

Problems with USE - using large amounts, more time spent with use, repeated attempts to control use

Problems with LIFESTYLE - physical/psych/social/interpersonal problems related to use, activities given up, neglected major roles, hazardous use

Problems with PHYSIOLOGY - craving, tolerance, withdrawal

Same as OUD

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3
Q

Most stimulants used are derivatives of…

A

Amphetamine

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4
Q

Stimulants physiological effect is to…

Stimulants are often refered to as…

A

Increase motivation, concentration, mood, energy, and wakefulness

Sympathomimetics - mimic physiological effects of epinephrine

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5
Q

The cycle of SUD is often…

A

Binging on stimulant - stimulant wears off = crash - experience cravings, repeat.

Tolerance + addiction end up developing

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6
Q

Strong stimulants include…

A

Cocaine
Methamphetamine
MDMA

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7
Q

The mechanism of stimulants is…

A

Increasing CNS + ANS activity
Effect reward pathway by increasing DA concentrations - outcome similar between stimulants, but intensity will vary

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8
Q

Cocaine and amphetamines are stronger stimulants pharmacologically, because…

A

Cocaine prevents re-uptake only of DA, 5-HT, NE
Amphetamines cause RELEASE of NT (DA, 5-HT, NE) from storage sites, and to various degrees also inhibit re-uptake

Long-term use depletes stores of NT which leads to tolerance

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9
Q

Stimulant effect on the CNS involves…

A

Intense euphoria
Increased alertness, concentration, talkativeness, sexual behaviour
Decreased appetite, fatigue

May see anxiety, agitation, nausea, tremors, twitches

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10
Q

Stimulant effect on the ANS involves…

A

Increase in body temperature, heart rate, blood pressure, respiratory rate, constriction of blood vessels (dilated pupils)

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11
Q

Overdose of stimulants can result in…

A

Seizures, coma, cardiac toxicity, respiratory arrest, brain hemorrhage, death

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12
Q

Immediate complications of stimulants may include…

A

Increased risk of violent/illegal behaviours
Increased engagement in risky sexual behaviour
Psychosis
Irritability

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13
Q

Long-term complications of stimulants may include…

A

Dental decay, weight loss, picking at skin with scabs, panic attacks
Brain changes, memory loss
Chronic psychotic disorders

Psychotic disorders can be secondary to repeated use, or unmasking of a primary disorder

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14
Q

A patient with acute stimulant intoxication or overdose may present with the following symptoms…

CNS, ANS overdrive

A

Mania, psychosis, paranoia, severe delirium

Increased BP, chest pain, agitation, sweating, skin-picking

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15
Q

Stimulant intoxication management is usually…

A

Supportive, unless patient is experiencing delusions, autonomic hyperactivity, or overtly agitated

Or severe crisis

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16
Q

For stimulant intoxication management, if a patient is acutely agitated, we could…

A

Consider BZD - lorazepam PRN
If does not help or in presence of psychotic sx’s, could add low dose AP

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17
Q

For stimulant intoxication management, if a patient is experiencing psychotic symptoms, we could…

A

Give low dose antipsychotic (risperidone 0.5-2mg/day, olanzapine 2.5-7.5 mg/day)

Delusions are often self-remitting without treatment (unless patient has been experiencing them chronically)

18
Q

For stimulant intoxication management, if a patient is experiencing cardiovascular complications, we could…

A

Give anti-arrythmic agents if arrythmia present
Give beta-blocker/clonidine for tachycardia +/- HTN

19
Q

For stimulant intoxication management, if a patient is experiencing seizures, we could…

A

Give anti-seizure medication if currently seizing (diazepam IV, midazolam IM)

No role in prevention

20
Q

Stage 1 of stimulant withdrawal starts…

Crash

A

Within hours, and lasts 4-7 days

21
Q

Signs and symptoms of stage 1 withdrawal include…

A

Hypersomnolence
Hyperphagia
Fatigue
Marked dysphoria
Fatigue, anorexia

22
Q

Stage 2 of stimulant withdrawal starts…

A

After the first week and can last up to 10 weeks

23
Q

Signs and symptoms of stage 2 withdrawal include…

A

1st week is normal (euthymia, little anxiety, minimal craving, normal sleep)

Subsequent weeks - anhedonia, increased anxiety, depression, fatigue
Extreme craving + fixation on use

24
Q

From a pharm perspective, stimulant withdrawal management is primarily…

A

Non-pharm: planning for addictions counselling, support, community support, rehab options, housing needs

25
Q

If post-acute hyperarousal/anxiety persists in stimulant withdrawal, we could…

A

Continue BZD’s for a little longer
Trial mirtazapine (mixed results)

26
Q

Goals of therapy in treating SUD include…

A

Achieving abstinence
Maintaining abstinence (tx ongoing withdrawal, craving, addictions)
Treating comorbid conditions (depression, anxiety)
Preventing harm to self and others

27
Q

Sustained neurophysiological changes from methamphetamine usage leads to…

A

Depressed mood
Anhedonia
Cognitive impairment
Poor health

28
Q

The biggest factor leading to relapse and challenges in managing SUD is…

A

Cravings

29
Q

Antidepressants were thought to help with SUD because ____, BUT…

A

5-HT may attenuate reinforcing effects of amphetamine and counter withdrawal symptoms of depression, but mixed results have been seen with abstinence

Mirtazapine had 1 positive RCT for amphetamine abstinence, but still not solid evidence

30
Q

Bottom line: antidepressant usage for abstinence is…

A

Mostly ineffective, but may have positive mood-related results. Use according to depression/anxiety guidelines if indicated

31
Q

Rationale for AP usage in SUD was ____, however…

A

They could counterbalance excess DA actvitity and restore NT pathways; however risked promoting cravings due to decreased dopamine increasing negative symptoms

32
Q

AP’s efficacy in SUD treatment showed…

A

No difference in any treatment outcomes (tx retention, abstinence, reduced use)

Aripiprazole showed increased cravings and use, likely due to impulse control issue

33
Q

We should use AP’s in SUD treatment if…

A

Indicated, according to psychosis guidelines. Review need after 6 months.

34
Q

Rationale for considering prescribed stimulants for SUD was…

A

Substitution/replacement therapy, similar to OAT

35
Q

Studies have shown that prescribed stimulants for SUD was…

A

Mixed results - possible reduction in use or cravings, but usually no difference in treatment outcomes were observed

Generally not recommended due to risk of worsening psychosis, and mood lability

36
Q

Rationale for considering dopamine agonists in SUD was that…

A

Chronic stimulant use led to DA depletion

37
Q

Studies have found that dopamine agonists….

A

General results were not promising - some possible benefit in severe withdrawal

38
Q

Evidence of modafinil is SUD is…

A

Mixed - possibly useful to reduec cocaine use, but has negative trials and risk of increased effect with concurrent stimulant usage.

39
Q

Evidence for bupropion + naltrexone is…

A

Statsitically significant compared to placebo; but still has a low response rate overall

40
Q

Mainstay of tx for SUD is…

A

Non-pharm: 1st line = psychosocial approaches (CBT, contingency management, addictions treatment)

Know where we can refer patients to

41
Q

The pharmacist role in SUD is…

A

Elimination of unnecessary/non-beneficial medications
Elimination of harmful medications (long term BZD, stimulants)
Help identify + treat comorbid mental or physical conditions

For other conditions treat according to guidelines independent of substance use, but also consider individual risk factors

Substance Use Disorders (6 decks)

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